The field of endoscopic surgery has been advancing rapidly in recent years. In this form of surgery, procedures are performed inside of the body of a patient using instruments inserted through small endosurgical ports in the body. The surgery is performed with the aid of an endoscope, which is a thin, tube-like instrument featuring a light source, viewing lenses, and/or various other attachments such as irrigators, scissors, snares, brushes, or forceps. Endoscopes may be flexible or rigid, and normally utilize optic fibers to transmit light to the internal cavity. The surgery is normally viewed by the surgeon through an ocular. Lenses are placed near the tip of the endoscope and the image thereon is transmitted via optic fibers or other lens systems, to the ocular or viewer. Other types of endoscopes utilize optical fibers to transmit electronic signals representing the internal image from the distal lens to a video monitor which is viewed by the surgeon.
This form of surgery allows internal visualization of the body structure without the necessity of excessive dissection of tissue. Typical endoscopes often are in the 5 to 12 mm diameter range and thus require only very small incisions to insert them into the body.
This form of surgery has developed rapidly because of the numerous benefits arising in favor of the patient. Since there is only a small incision to permit entrance of the endoscope, endoscopic surgery results in less trauma to the body and faster patient recovery. For the benefits of endoscopic surgery to arise, however, all aspects of the surgery, such as the initial examination, retraction, and the surgical procedure itself, must be accomplished through small surgical incisions or ports.
The obvious difficulty associated with endoscopic surgery is inadequate visualization of the internal structure required to properly complete the surgical procedure. Endoscopic surgery is thus difficult in areas which are typically difficult to reach, such as the gallbladder. In gallbladder surgery, (or "cholecystectomy") the tissue and organs surrounding the gallbladder are examined with the endoscope and retracted in order to properly expose the organ which is to be removed.
Currently, endoscopic procedures in the abdominal cavity, otherwise known as laparoscopy, often require retraction. Specifically, endoscopic cholecystectomy requires retraction of the liver, which rests directly above the gallbladder. In an open surgery operation, retraction is relatively easy, as the surgery involves the exposure of the entire organ area. In order to obtain the benefits of endoscopic surgery, however, a form of retraction which can be accomplished through ports is necessary.
In an endoscopic procedure involving the gallbladder or other abdominal organs, retraction is currently accomplished by inflating the peritoneal cavity with carbon dioxide. This method of retraction involves creating a small surgical port for introducing a gas source. The gas is introduced into the body through a cannula, and a state of pneumoperitoneum occurs. The gas inflates the peritoneal cavity so as to cause the skin and muscles to separate and rise above various organs and tissue, thus creating the exposure necessary to accomplish the endoscopic surgery.
Several problems are associated with pneumoperitoneal retraction, however. First of all, exposure remains adequate only while the required pneumoperitoneal state remains. Since endoscopic surgery normally requires the introduction of at least the endoscope, and more often several other tools, a number of surgical ports will most likely be created in the body. Each of these ports, which normally use a cannula to keep them open for access, in effect create an exhaust port for the gas. The risk that insufflation pressure may be lost increases the risk that the endoscopic procedure may go awry as adequate exposure for the endoscope is extinguished.
Further, there are many complications which are associated with persistent pneumoperitoneum during an endoscopic procedure. Acute cardiovascular collapse secondary to over-distension of the abdomen, vasovagal reflex activation, cardiac arrhythmia, pneumothorax, subcutaneous emphysema, alteration of large vein venous return, retinal hemorrhage, blindness, carbon dioxide embolism, and general patient discomfort have all been associated with persistent pneumoperitoneum.
Lastly, pneumoperitoneal retraction is effective in retracting only the muscles and tissue from above the organs. The organs themselves are not, to a great extent, retracted from each other.
There is therefore a need for a device and method which provides retraction in conjunction with endoscopic procedures, which is effective in providing adequate visualization and access, and which is safe and has fewer side effects than current methods.